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[Pharmacology](https://durgical.com/en/pharmacology/) · Class

# Echinocandins

Intravenous antifungals that block making of the fungal cell wall. First choice for candidaemia; human cells have no such wall.

Updated 2026-11-01

## What they are

Large lipopeptides given only by vein. They kill Candida (fungicidal) and slow Aspergillus (fungistatic). They do not reach the CSF and do not cover Cryptococcus, the dimorphic fungi or the agents of mucormycosis.

## Mechanism of action

They inhibit β-1,3-D-glucan synthase (the Fks subunit), the membrane enzyme that builds the glucan chains of the fungal cell wall. Without glucan the wall weakens and the yeast bursts under its own pressure. Mammalian cells contain no β-1,3-D-glucan, which explains the good tolerance.

Target: β-1,3-D-glucan synthase (Fks1)

## Key points

- Block β-1,3-D-glucan synthesis: the 'penicillin of fungi' acts on the wall, not the membrane.
- First-line initial treatment of candidaemia.
- No CSF penetration and no activity against Cryptococcus: never for cryptococcal meningitis.
- Only intravenous; a too-fast infusion can cause histamine-type reactions (flushing, rash, itching).
- Few CYP interactions compared with azoles; liver enzyme rises are the main laboratory effect.

## Drugs in this class

- [**Caspofungin** Intravenous echinocandin that blocks the fungal cell wall. Used for candidaemia, oesophageal candidiasis and as rescue… β-1,3-D-glucan synthase (Fks1 catalytic subunit)](https://durgical.com/en/pharmacology/caspofungin/)
- [**Micafungin** Intravenous echinocandin for candidaemia, oesophageal candidiasis and prevention of Candida infection in stem cell… β-1,3-D-glucan synthase (Fks1 catalytic subunit)](https://durgical.com/en/pharmacology/micafungin/)

## Others in the class

- anidulafungin
- rezafungin

## Test yourself

Think of the answer, then tap the question to see it.

## Why are echinocandins so well tolerated?

Their target, β-1,3-D-glucan in the fungal cell wall, does not exist in human cells.

## A patient with HIV has cryptococcal meningitis. Is caspofungin an option?

No. Echinocandins have no useful activity against Cryptococcus and do not penetrate the CSF; amphotericin B plus flucytosine is used.

## Against which fungus are echinocandins fungicidal, and against which only fungistatic?

Fungicidal against Candida; fungistatic against Aspergillus, where they change the shape of the growing hyphae.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - CASPOFUNGIN ACETATE injection, powder, lyophilized, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=08fb61ee-a05a-4ce1-934c-8cd26c5733db) (DailyMed (U.S. National Library of Medicine), 2026); [DailyMed - MICAFUNGIN- micafungin sodium injection, powder, lyophilized, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=33e579c1-b315-44cb-a690-e2dd2cdf44ee) (DailyMed (U.S. National Library of Medicine), 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 61 (McGraw Hill, 2023).

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Representative model, for educational purposes only.

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